Osteoporosis International

, Volume 26, Issue 4, pp 1381–1386

Association between fat mass, lean mass, and bone loss: the Dubbo osteoporosis epidemiology study

  • S. Yang
  • J. R. Center
  • J. A. Eisman
  • T. V. Nguyen
Original Article



Lower body fat mass is a risk factor for bone loss at lumbar spine in postmenopausal women, but not in men. Body lean mass and fat mass were not associated with femoral neck bone loss in either gender.


Bone density and body mass are closely associated. Whole body lean mass (LM) and fat mass (FM) together account for approximately 95 % of body mass. Bone loss is associated with loss of body mass but which of the components of body mass (FM or LM) is related to bone loss is not well understood. Therefore, in this study, we sought to assess whether baseline FM or LM has predictive value for future relative rate of bone mineral density (BMD) changes (%/year).


The present population-based cohort study was part of the ongoing Dubbo Osteoporosis Epidemiology Study (DOES). BMD, FM, and LM were measured with dual energy X-ray absorptiometry (GE-LUNAR Corp, Madison, WI). BMD measurements were taken in approximately every 2 years between 2000 and 2010. We only included the participants with at least two BMD measurements at the femoral neck and lumbar spine. In total, 717 individuals (204 men and 513 women) aged 50 years or older were studied.


Rate of bone loss at femoral neck and lumbar spine was faster in women than in men (all P < 0.01). In bivariable regression analysis, each 5 kg greater FM in women was associated with 0.4 %/year (P = 0.003) lower bone loss at lumbar spine. This magnitude of association remained virtually unchanged after adjusting for LM and/or other covariates (P = 0.03). After adjusting for covariates, variation of FM accounted for ∼1.5 % total variation in lumbar spine bone loss. However, there was no significant association between FM and change in femoral neck BMD in either men or women.


Lower FM was an independent but modest risk factor for greater bone loss at the lumbar spine in women but not in men. If further studies confirm our findings, FM can help predict lumbar spine bone loss in women.


Body composition Bone loss Fat mass Lean mass Osteoporosis 


  1. 1.
    Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141CrossRefPubMedGoogle Scholar
  2. 2.
    Burger H, de Laet CE, van Daele PL, Weel AE, Witteman JC, Hofman A, Pols HA (1998) Risk factors for increased bone loss in an elderly population: the Rotterdam Study. Am J Epidemiol 147:871–879CrossRefPubMedGoogle Scholar
  3. 3.
    Jones G, Nguyen T, Sambrook P, Kelly PJ, Eisman JA (1994) Progressive loss of bone in the femoral-neck in elderly people - longitudinal findings from the Dubbo osteoporosis epidemiology study. Brit Med J 309:691–695CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Ensrud KE, Palermo L, Black DM, Cauley J, Jergas M, Orwoll ES, Nevitt MC, Fox KM, Cummings SR (1995) Hip and calcaneal bone loss increase with advancing age—longitudinal results from the study of osteoporotic fractures. J Bone Miner Res 10:1778–1787CrossRefPubMedGoogle Scholar
  5. 5.
    Nguyen TV, Center JR, Eisman JA (2005) Femoral neck bone loss predicts fracture risk independent of baseline BMD. J Bone Miner Res 20:1195–1201CrossRefPubMedGoogle Scholar
  6. 6.
    Nguyen ND, Center JR, Eisman JA, Nguyen TV (2005) Bone loss and weight fluctuation predict mortality risk in elderly men and women. J Bone Miner Res 20:S268–S268Google Scholar
  7. 7.
    Nguyen ND, Center JR, Eisman JA, Nguyen TV (2007) Bone loss, weight loss, and weight fluctuation predict mortality risk in elderly men and women. J Bone Miner Res 22:1147–1154CrossRefPubMedGoogle Scholar
  8. 8.
    Siris ES, Chen Y-T, Abbott TA, Barrett-Connor E, Miller PD, Wehren LE, Berger ML (2004) Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med 164:1108–1112CrossRefPubMedGoogle Scholar
  9. 9.
    Shapses SA, Riedt CS (2006) Bone, body weight, and weight reduction: what are the concerns? J Nutr 136:1453–1456PubMedCentralPubMedGoogle Scholar
  10. 10.
    Knoke JD, Barrett-Connor E (2003) Weight loss: a determinant of hip bone loss in older men and women—the Rancho Bernardo study. Am J Epidemiol 158:1132–1138CrossRefPubMedGoogle Scholar
  11. 11.
    Hsu Y-H, Venners SA, Terwedow HA et al (2006) Relation of body composition, fat mass, and serum lipids to osteoporotic fractures and bone mineral density in Chinese men and women. Am J Clin Nutr 83:146–154PubMedGoogle Scholar
  12. 12.
    Jones G, Nguyen T, Sambrook PN, Kelly PJ, Gilbert C, Eisman JA (1994) Symptomatic fracture incidence in elderly men and women—the Dubbo-osteoporosis-epidemiology-study (Does). Osteoporos Int 4:277–282CrossRefPubMedGoogle Scholar
  13. 13.
    Yang SM, Nguyen ND, Center JR, Eisman JA, Nguyen TV (2013) Association between abdominal obesity and fracture risk: a prospective study. J Clin Endocrinol Metab 98:2478–2483CrossRefPubMedGoogle Scholar
  14. 14.
    Kannel WB, Sorlie P, Kannel WB, Sorlie P (1979) Some health benefits of physical activity. the Framingham study. Arch Intern Med 139:857–861CrossRefPubMedGoogle Scholar
  15. 15.
    Nguyen ND, Frost SA, Center JR, Eisman JA, Nguyen TV (2008) Development of prognostic nomograms for individualizing 5-year and 10-year fracture risks. Osteoporos Int 19:1431–1444CrossRefPubMedGoogle Scholar
  16. 16.
    Nguyen TV, Howard GM, Kelly PJ, Eisman JA (1998) Bone mass, lean mass, and fat mass: same genes or same environments? Am J Epidemiol 147:3–16CrossRefPubMedGoogle Scholar
  17. 17.
    Douchi T, Kuwahata R, Matsuo T, Uto H, Oki T, Nagata Y (2003) Relative contribution of lean and fat mass component to bone mineral density in males. J Bone Miner Metab 21:17–21CrossRefPubMedGoogle Scholar
  18. 18.
    Saarelainen J, Honkanen R, Kroger H, Tuppurainen M, Jurvelin JS, Niskanen L (2011) Body fat distribution is associated with lumbar spine bone density independently of body weight in postmenopausal women. Maturitas 69:86–90CrossRefPubMedGoogle Scholar
  19. 19.
    Reid IR, Ames RW, Evans MC, Sharpe SJ, Gamble GD (1994) Determinants of the rate of bone loss in normal postmenopausal women. J Clin Endocrinol Metab 79:950–954PubMedGoogle Scholar
  20. 20.
    Haderslev KV, Tjellesen L, Sorensen HA, Staun M (2000) Alendronate increases lumbar spine bone mineral density in patients with Crohn’s disease. Gastroenterology 119:639–646CrossRefPubMedGoogle Scholar
  21. 21.
    Ensrud KE, Barrett-Connor EL, Schwartz A et al (2004) Randomized trial of effect of alendronate continuation versus discontinuation in women with low BMD: results from the fracture intervention trial long-term extension. J Bone Miner Res 19:1259–1269CrossRefPubMedGoogle Scholar
  22. 22.
    Reeve J, Walton J, Russell LJ et al (1999) Determinants of the first decade of bone loss after menopause at spine, hip and radius. QJM 92:261–273CrossRefPubMedGoogle Scholar
  23. 23.
    Grumbach MM (2000) Estrogen, bone, growth and sex: a sea change in conventional wisdom. J Pediatr Endocrinol Metab 13(Suppl 6):1439–1455PubMedGoogle Scholar
  24. 24.
    Thomas T, Burguera B (2002) Is leptin the link between fat and bone mass? J Bone Miner Res 17:1563–1569CrossRefPubMedGoogle Scholar
  25. 25.
    Oh KW, Lee WY, Rhee EJ et al (2005) The relationship between serum resistin, leptin, adiponectin, ghrelin levels and bone mineral density in middle-aged men. Clin Endocrinol (Oxf) 63:131–138CrossRefGoogle Scholar
  26. 26.
    Franchimont N, Wertz S, Malaise M (2005) Interleukin-6: an osteotropic factor influencing bone formation? Bone 37:601–606CrossRefPubMedGoogle Scholar
  27. 27.
    Nguyen TV, Center JR, Eisman JA (2005) Femoral neck bone loss predicts fracture risk independent of baseline BMD. J Bone Miner Res 20:1195–1201CrossRefPubMedGoogle Scholar
  28. 28.
    Riis BJ, Hansen MA, Jensen AM, Overgaard K, Christiansen C (1996) Low bone mass and fast rate of bone loss at menopause: equal risk factors for future fracture: a 15-year follow-up study. Bone 19:9–12CrossRefPubMedGoogle Scholar
  29. 29.
    Frost SA, Nguyen ND, Center JR, Eisman JA, Nguyen TV (2009) Timing of repeat BMD measurements: development of an absolute risk-based prognostic model. J Bone Miner Res 24:1800–1807CrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2014

Authors and Affiliations

  • S. Yang
    • 1
  • J. R. Center
    • 1
    • 2
  • J. A. Eisman
    • 1
    • 2
    • 3
  • T. V. Nguyen
    • 1
    • 4
    • 5
  1. 1.Osteoporosis and Bone Biology Research ProgramGarvan Institute of Medical ResearchDarlinghurstAustralia
  2. 2.Department of EndocrinologySt Vincent’s HospitalSydneyAustralia
  3. 3.School of MedicineThe University of Notre Dame AustraliaFremantleAustralia
  4. 4.School of Public Health & Community Medicine, Faculty of MedicineUniversity of New South WalesSydneyAustralia
  5. 5.Centre for Health TechnologiesUniversity of TechnologySydneyAustralia

Personalised recommendations